Implementing a care bundle approach reduces ventilator-associated pneumonia and delays ventilator-associated tracheobronchitis in children: differences according to endotracheal or tracheostomy devices

Objective: The aim of this study was to identify microorganisms causing ventilator-associated pneumonia (VAP) and also study the antibiotic resistance/susceptibility. Materials and Methods:We retrospectively assessed microorganisms isolated from patients diagnosed with VAP in a pediatric intensive care unit between January 1, 2014, and June 30, 2016. Results:We included 44 patients diagnosed with VAP. The prevalence thereof was 8.6 patients per 1,000 ventilator days. Mechanical ventilation was required for 56.5% of patients. Thirty-three patients (75%) died. An underlying chronic disease was detected in 75% of patients (n=33). Fifty microorganisms were isolated from 44 patients. Single microorganisms were isolated from 86.4% (n=38) and two from 13.6% (n=6) of patients. Of all the isolated bacteria, 96% (n=48) were gram-negative; the most common was Pseudomonas aeruginosa (32%), followed by Klebsiella pneumoniae (24%) and Acinetobacter baumannii (22%). The isolates were most susceptible to colistin (92.6%), followed by piperacillin-tazobactam (71.4%), amikacin (65.2%), and gentamicin (52.2%). No enterobacterium or Acinetobacter strain was resistant to colistin; however, 13% of P. aeruginosa isolates were resistant. Conclusion:In VAP, it is essential to catalog antibiotic resistance patterns of bacteria present in the unit to ensure that empirical antibiotic therapy is effective.Keywords: Ventilator-associated pneumonia, pediatric intensive care, microorganism, antibiotic Bulgular: Çalışmaya VİP tanısı alan 44 hasta alındı. VİP hızı 1000 ventilatör gününde 8,6 olarak saptandı. Mekanik ventilatör kullanım oranı %56,5 idi. VİP tanısı alan olguların %75 (n=33)'nin öldüğü saptandı. VİP tanısı alan hastaların %75 (n=33)'inde altta yatan kronik hastalık tespit edildi. VİP tespit edilen 44 olguda 50 mikroorganizma izole edildi. Olguların %86,4'nda (n=38) tek mikroorganizma, %13.6 (n=6)'nda iki mikroorganizma etken olarak izole edildi. İzole edilen suşların %96' sının (n=48) gram negatif bakteri olduğu saptandı. Çalış-mamızda en sık izole edilen gram negatif ajan Pseudomonas Aeruginosa (%32) iken bunu Klebsiella pneumonia (%24) ve Acinetobacter baumannii (%22) izlemekte idi. Genel antibiyotik duyarlılığı incelendiğinde mikroorganizmaların en hassas olduğu antibiyotikler sırasıyla Kolistin (%92,6), Piperasilin-tazobaktam (% 71,4), Amikasin (%65,2) ve Gentamisin (%52,2) olarak saptandı. Enterobacteriaceae ve Acinetobacter suşlarında Kolistin direnci görülmezken P. aeruginosa izolatlarında, kolistin direnci %13 olarak saptandı.Sonuç: Ventilatör ilişkili pnömonidee, etkili ampirik antibiyotik tedavisi için her ünitenin kendi florasının direnç özelliklerini bilmesi gerekmektedir.Anahtar Kelimeler: Ventilatör ilişkili pnömoni, çocuk yoğun bakım, mikroorganizma, antibiyotik Eurasian J Med

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“…Hand hygiene is important to minimize contact transmission [11]. Staff training is equally essential, as is prospective nosocomial surveillance.…”

Section: (2)mentioning

confidence: 99%

Evaluation of Microorganisms Causing Ventilator-Associated Pneumonia in a Pediatric Intensive Care Unit

et al. 2017

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“…The following eight studies involving at least 3,989 participants were included in this systematic review (Azab et al, ; Bigham et al, ; Brierley et al, ; Brilli et al, ; Ceballos et al, ; DeCristofano et al, ; Haque et al, ; Peña‐López et al, ). One study was excluded from counting the number of participants as the authors did not report the sample size (Ceballos et al, ).…”

Section: Resultsmentioning

confidence: 99%

“…One study was excluded from counting the number of participants as the authors did not report the sample size (Ceballos et al, ). Three of the eight studies were cohort studies (Bigham et al, ; Haque et al, ; Peña‐López et al, ), two were following implementation of ventilator bundles studies (Brierley et al, ; Ceballos et al, ), one was a before‐and‐after intervention prospective study (Azab et al, ), one was a retrospective case control study (Brilli et al, ), and one study was a quasi‐experimental uninterrupted time series (DeCristofano et al, ). Of the eight reviewed studies, three were conducted in the United States (Bigham et al, ; Brilli et al, ; Ceballos et al, ), one in the UK (Brierley et al, ), one in Spain (Peña‐López et al, ), one in Argentina (DeCristofano et al, ), one in Egypt (Azab et al, ) and one in Pakistan (Haque et al, ).…”

Section: Resultsmentioning

confidence: 99%

“…Similarly, Brilli et al (), conducted their research in the PICU which delivers care to critically ill patients with an underlying medical illness, following emergency trauma surgeries, general surgeries and post organ transplantation. Peña‐López et al (), conducted a cohort study in the medical‐surgical PICU which serves for transplant, burns, haematological/oncological and immunocompromised patients. Ceballos et al () performed the risk stratification on all neonates included in the study on the basis of weight categories in accordance with National Healthcare Safety Network reporting requirements as follows: <750 g, 751–100 g, 1,501–2,500 g and >2,500 g.…”

Section: Resultsmentioning

confidence: 99%

“…The preintervention and postintervention VAP rates were defined as the number of VAP episodes per 1,000 ventilator days in each of the eight studies. Five of the eight studies (Azab et al, ; Bigham et al, ; Brilli et al, ; DeCristofano et al, ; Peña‐López et al, ) reported the use of ventilator bundles which resulted in statistically significant decreases in VAP rates in the postintervention phases in mechanically ventilated patients in the NICU and PICU. According to the authors, the p ‐value varied from <.0001 to <.028.…”

Section: Resultsmentioning

confidence: 99%

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What are the effects of care bundles on the incidence of ventilator‐associated pneumonia in paediatric and neonatal intensive care units? A systematic review

Niedzwiecka

Patton

Walsh

et al. 2019

Specialist Pediatric Nursing

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Purpose The purpose of this review was to ascertain the impact of ventilator bundles on the incidence of ventilator‐associated pneumonia in mechanically ventilated neonates and children in intensive care units. Methods A systematic review was conducted. Key computerised databases (CINAHL, Medline, Embase and Cochrane) as well as additional sources, with no publication date limitations, were extensively searched in January 2018. Inclusion criteria focused on ventilator bundles used in mechanically ventilated neonates and children aged from 0 to 18 years. After identification and inclusion, all studies were critically appraised for quality. Data were analysed and narratively synthesised. Results Eight studies of observational and nonrandomised interventional methods design were included in the review. However, the validity of five of the eight studies which were reviewed was considered substandard. In addition, there were variations in the care bundles elements studied. Nevertheless, all these studies demonstrated that the incidences of VAP in mechanically ventilated neonates and children were found to be significantly reduced by the use of ventilator bundles. Practice Implications This systematic review determines that ventilator bundles impact positively on the incidence of VAP in critically ill neonates and children in the neonatal intensive care unit and paediatric intensive care unit. However, the variations in the bundle elements and insufficient valid evidence necessitates further research in the area to validate the findings and to ensure standardisation of clinical practice. Prevention of VAP is aimed at avoiding the risk of aspiration in the lungs, colonisation of respiratory tract with pathogenic microorganisms and contamination of respiratory equipment. Moreover, the implementation of evidence‐based interventions grouped together is fundamental to improve patient outcomes. It is recommended that a further bona fide research is required to standardise the components of paediatric ventilator bundles.

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Economic Evaluation of Pediatric Tracheostomy: A Cost of Illness Analysis

Zhang,

Liu,

Narayanan

et al. 2024

OTO Open

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ObjectiveThis study aimed to determine the direct costs of pediatric tracheostomy care within a health care system.Study DesignProspective analysis.SettingAcademic children's hospital.MethodsCosts associated with caring for pediatric tracheostomy patients under 18 years were analyzed between 2015 and 2021. Direct costs were calculated using the Medicare/Medicaid charges‐to‐costs ratio for various visit types. Costs were estimated using generalized linear equations, accounting for confounders.ResultsA total of 297 children underwent tracheostomy at a median age of 0.94 years. The median follow‐up was 2.5 years, resulting in 13,966 visits (mean = 41). The total cost was $321 million. The initial admission accounted for 72% ($231 million) of costs while other inpatient admissions added 24% ($78 million). Emergency department, observation, and outpatient visits comprised 4% of costs. The length of stay (LOS) was the primary cost driver for inpatient visits. Each additional hospital day increased costs by roughly $1195, and each extra admission added about $130,223 after adjusting for confounders. Respiratory failure and infections were the primary reasons for 67% of subsequent admissions.ConclusionPediatric tracheostomy care generated over $300 million in direct costs over 5 years. Inpatient stays constituted 96% of these costs, with the LOS being a major factor. To reduce direct health expenditures for these patients, the focus should be on minimizing admissions.

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Implementing a care bundle approach reduces ventilator-associated pneumonia and delays ventilator-associated tracheobronchitis in children: differences according to endotracheal or tracheostomy devices

Cited by 35 publications

References 24 publications

Evaluation of Microorganisms Causing Ventilator-Associated Pneumonia in a Pediatric Intensive Care Unit

Evaluation of Microorganisms Causing Ventilator-Associated Pneumonia in a Pediatric Intensive Care Unit

What are the effects of care bundles on the incidence of ventilator‐associated pneumonia in paediatric and neonatal intensive care units? A systematic review

Economic Evaluation of Pediatric Tracheostomy: A Cost of Illness Analysis

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